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........................

RAILWAY
CM257
RESERVATION/CANCELLATION REQUISITION FORM
If you are a Medical Practitioner Please tick ( ) in Box (You could be of help in an emergency)

Dr.

If you want Sr. Citizen concession, please write Yes/No in box (if yes, please carry a proof of
age during the journey to avoid inconvenience of penal charging under extant Railway Rules)

Do you want to be upgraded without any extra charge? Write Yes/No in


the box. (If this option is not exercised, full fare paying passengers may be upgraded
automatically)
Train No & Name ______________________________________ Date of journey______________________
Class ____________________________

No of Berth/Seat_______

Station from _________________________________ To __________________________________________


Boarding at ______________________________ Reservation upto _________________________________

S.No.

Name in Block letter(not more


than 15 chars)

Sex(M/F)

Age

Concession/TravelAuthority
Choice if any
No.

1.

Lower/Upper
berth
Veg./Nonveg. Meal for
Rajdhani/
Shatabdi
Express Only

2.
3.
4.
5.

CHILDREN BELOW 5 YEARS (FOR WHOM TICKET IS NOT TO BE ISSUED)

S.No.

Name in Block Letters

Sex

Age

ONWARD/RETURN JOURNEY DETAILS


Train No & Name _____________________________________ Date of journey______________________
Class ________ Station from:____________________________ To__________________________________
Name of applicant _______________________________________________________
Full Address ______________________________________________________________________________
Signature of the Applicant/Representative
Telephone No., if any ____________________________ Date ______________Time ________________

FOR OFFICE USE ONLY


S.No. of Requistion______________________________________ PNR No._____________________________
Berth/Seat No.___________________ Amount collected _____________________________________________
___________________________________________
Signature of Reservation Clerk

........................ RAILWAY
CM257
RESERVATION/CANCELLATION REQUISITION FORM
If you are a Medical Practitioner Please tick ( ) in Box (You could be of help in an emergency)

Dr.

If you want Sr. Citizen concession, please write Yes/No in box (if yes, please carry a proof of
age during the journey to avoid inconvenience of penal charging under extant Railway Rules)

Do you want to be upgraded without any extra charge? Write Yes/No in


the box. (If this option is not exercised, full fare paying passengers may be upgraded
automatically)
Train No & Name ___________________ Date of journey______________________
Class ____________________________ No of Berth/Seat_______
Station from _______________________ To __________________
Boarding at ______________________ Reservation upto _____________________

S.No.

Name in Block letter(not more


than 15 chars)

Sex(M/F)

Age

Concession/TravelAuthority
Choice if any
No.

1.

Lower/Upper
berth
Veg./Nonveg. Meal for
Rajdhani/
Shatabdi
Express Only

2.
3.
4.
5.

CHILDREN BELOW 5 YEARS (FOR WHOM TICKET IS NOT TO BE ISSUED)

S.No.

Name in Block Letters

Sex

ONWARD/RETURN JOURNEY DETAILS


Train No. & Name________________________ Date ________________________
Class ________ Station from:___________________ To________________________
Name of applicant _______________________________________________________
Full Address ___________________________________________________________
Signature of the Applicant/Representative
Telephone No., if any _______________________ Date __________Time __________

FOR OFFICE USE ONLY


S.No. of Requistion_______________________ PNR No._______________________
Berth/Seat No._______________ Amount collected _____________________________
_________________________
Signature of Reservation Clerk

Age

........................ RAILWAY
CM257
RESERVATION/CANCELLATION REQUISITION FORM
If you are a Medical Practitioner Please tick ( ) in Box (You could be of help in an emergency)

Dr.

If you want Sr. Citizen concession, please write Yes/No in box (if yes, please carry a proof of
age during the journey to avoid inconvenience of penal charging under extant Railway Rules)

Do you want to be upgraded without any extra charge? Write Yes/No in


the box. (If this option is not exercised, full fare paying passengers may be upgraded
automatically)
Train No & Name ___________________ Date of journey______________________
Class ____________________________ No of Berth/Seat_______
Station from _______________________ To __________________
Boarding at ______________________ Reservation upto _____________________

S.No.

Name in Block letter(not more


than 15 chars)

Sex(M/F)

Age

Concession/TravelAuthority
Choice if any
No.

1.

Lower/Upper
berth
Veg./Nonveg. Meal for
Rajdhani/
Shatabdi
Express Only

2.
3.
4.
5.

CHILDREN BELOW 5 YEARS (FOR WHOM TICKET IS NOT TO BE ISSUED)

S.No.

Name in Block Letters

Sex

ONWARD/RETURN JOURNEY DETAILS


Train No. & Name________________________ Date ________________________
Class ________ Station from:___________________ To________________________
Name of applicant _______________________________________________________
Full Address ___________________________________________________________
Signature of the Applicant/Representative
Telephone No., if any _______________________ Date __________Time __________

FOR OFFICE USE ONLY


S.No. of Requistion_______________________ PNR No._______________________
Berth/Seat No._______________ Amount collected _____________________________
_________________________
Signature of Reservation Clerk

Age